Annals of Occupational and Environmental Medicine

Original article

A proposed screening protocol for musculoskeletal disorders among Korean fishers: results from field application: Soohyeong Park, Hyemin Kim, Bonggyun Ju, Chulgab Lee, Hansoo Song; Ann Occup Environ Med 2026;e44. Published online October 7, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e44 [Accepted]

Abstract PDF: Background
Musculoskeletal disorders (MSDs) are highly prevalent in physically demanding occupations, including fisheries; however, standardized and field-applicable screening approaches remain limited. The lack of practical frameworks integrating symptoms, functional impairments, and objective findings constrains early identification and prevention in occupational settings. This study applied a structured musculoskeletal screening protocol to characterize musculoskeletal conditions among Korean fishermen and evaluate its feasibility in occupational health settings.
Methods
This field-based study included 329 fishers who participated in a health-screening program. The protocol integrated standardized questionnaires (Western Ontario and McMaster Universities Arthritis Index Short Form, Oswestry Disability Index, and QuickDASH), physical examinations, and radiographic assessments. Percentile-based thresholds (upper 20% of normalized scores) were used to identify a higher symptom burden. Participants were classified into Adequate, Caution, and Disorder-level (screen-positive) groups based on predefined operational criteria. Physical workload was assessed using a structured questionnaire, and a physical strain score was calculated as a relative index of musculoskeletal workload. Logistic regression analyses explored associations with occupational factors.
Results
Among the participants (mean age, 60.4 years; 63.2% male), 46.5% were classified into the Disorder-level group for at least one condition, and 90.9% were classified into either the Disorder-level or Caution group. Upper extremity MSDs were the most frequently identified condition (32.5%). Higher physical strain scores were associated with an increased likelihood of Disorder-level classification, particularly for upper extremity MSDs (adjusted odds ratio [aOR], 3.30–3.75) and degenerative lumbar disorder (aOR, 4.98–10.97). Differences were also observed by fishing type, with higher lumbar involvement among aquaculture workers.
Conclusions
This study presents a structured screening protocol for MSDs among fishers and demonstrates its feasibility and applicability in field settings. The protocol may support risk stratification and the identification of individuals requiring further evaluation or preventive management. The diagnostic performance and longitudinal impact of this method warrant further investigation.

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Original article

Toward revising Korea's occupational blood-lead regulations for lead-exposed workers: associations between blood lead levels and biological markers in Korean National Environmental Health Survey (KoNEHS) cycles 3–5 (2015–2023): Chul Gab Lee; Ann Occup Environ Med 2026;e43. Published online October 2, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e43 [Accepted]

Abstract PDF: Background
Lead toxicity manifests at blood lead concentrations (BPb) well below the limits stipulated in Korea's occupational regulations, which set a surveillance trigger at 30 μg/dL and an occupational-disease threshold at 40 μg/dL. This study investigated subclinical effects in a Korean population with low exposure and assessed whether these findings could inform revision of Korea's occupational blood-lead regulations.
Methods
Data from three Korean National Environmental Health Survey cycles were analyzed (KoNEHS 3–5, 2015–2023; adults ≥19 years). Whole-blood lead was measured by inductively coupled plasma mass spectrometry. BPb distributions were summarized by cycle, sex, age, and occupation. Covariate-adjusted partial correlations (r) between log-BPb and erythropoietic markers (hemoglobin, hematocrit, red blood cell [RBC] count, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration [MCHC]), glycemic (glycated hemoglobin [HbA1c]), and renal glomerular filtration rate (serum β2-microglobulin [β2-MG]) biomarkers were computed across six BPb cut-offs (1.0–3.5 μg/dL) and characterized with restricted cubic splines.
Results
The weighted geometric mean (GM) BPb was 1.52 μg/dL (P97.5 4.03 μg/dL). Inter-occupational differences in BPb remained modest after adjusting for key covariates (sex, age, cycle, smoking, alcohol, exercise). Hemoglobin, hematocrit, and RBC count rose at low BPb but reversed to negative correlations above ≈2.2–2.5 μg/dL, reaching r ≈ −0.10 to −0.15 above 3.0 μg/dL; MCHC showed a weaker reversal (≈1.7 μg/dL). The hematologic sign-reversal persisted within risk occupations and most sex-age strata, most pronounced in men. Serum β2-MG increased monotonically with blood lead (adjusted pcur = 0.002, plin < 0.001), and HbA1c declined monotonically.
Conclusions
In a representative Korean sample, blood lead levels show subclinical hematologic signals below 3 μg/dL, far below the current occupational reference values, indicating that these values are unlikely to remain appropriate and that their revision is warranted. The phased strengthening presented as an illustrative policy scenario should proceed through scientific evaluation followed by stakeholder consultation to ensure both health protection and feasibility.

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Original Article

Association between organochlorine pesticides, polychlorinated biphenyls mixture and cardiometabolic outcomes: Findings from the Korean National Environmental Health Survey (KoNEHS): Jinwoo Han, Jong-Tae Park, Jaeyoon Lee, Kyeongmin Kwak; Ann Occup Environ Med 2026;e42. Published online September 14, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e42 [Accepted]

Abstract PDF: Background
Environmental chemical exposures rarely occur as isolated compounds. Instead, individuals are typically exposed to complex mixtures originating from multiple sources. Therefore, evaluating the combined health effects of correlated environmental chemicals through mixture-based approaches is essential.
Methods
This study applied quantile g-computation, a regression-based method designed to estimate the joint effects of correlated exposures. Among 4,279 participants in cycle 5 of the Korean National Environmental Health Survey (KoNEHS), 1,383 participants were included in the final analysis. The exposure mixture included persistent organic pollutants (POPs), specifically organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs). Associations with cardiometabolic outcomes, including HbA1c and lipid profile indicators, were evaluated using six hierarchical regression models with increasing levels of covariate adjustment and stratification. For statistically significant results, the relative contribution and directional influence of individual chemicals within the mixture were quantified using estimated mixture weights.
Results
Across the hierarchical regression models, mixture effects were more pronounced for lipid metabolism than for glycemic outcomes. Within the OCP mixture, β-hexachlorocyclohexane and p,p’-DDE consistently showed the largest positive contributions. Within the PCB mixture, PCB74 and PCB153 were the dominant contributors, particularly for lipid-related outcomes.
Conclusions
Overall, these findings support the importance of mixture-based analytical approaches and suggest that dyslipidemia may represent a key pathway linking POP exposure to cardiometabolic risk.

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Original Article

Association between seafood consumption and urinary bisphenol concentrations in Korean adults: findings from the Korean National Environmental Health Survey (KoNEHS 2018–2020): Seong-Ho Moon, Kwang Hee Jo, Soonsu Shin, Jae-Hong Ryoo; Ann Occup Environ Med 2026;e40. Published online September 1, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e40 [Accepted]

Abstract PDF: Background
This study aimed to examine exploratory cross-sectional associations between seafood-consumption frequency and spot urinary concentrations of bisphenol A (BPA), bisphenol F (BPF), and bisphenol S (BPS) in Korean adults and to present descriptive sex-stratified estimates.
Methods
Seafood-consumption frequency was assessed using a semi-quantitative food frequency questionnaire, whereas BPA, BPF, and BPS were measured in a single spot urine sample and dilution-adjusted using covariate-adjusted standardization. We analyzed 4,201 adults from the Korean National Environmental Health Survey 2018–2020. Seafood consumption (six groups) was classified as rarely, ≤once/week, or >once/week. Sex-stratified survey-weighted logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for high exposure (≥75th percentile), adjusting for sociodemographic factors, health behaviours, and food-contact behaviours. Sensitivity analyses used survey-weighted linear regression with ln-transformed concentrations.
Results
Median urinary concentrations were higher in men than in women for all three bisphenols. In men, seaweed consumption >once/week was associated with higher odds of high BPA exposure (OR: 2.34; 95% CI: 1.18–4.63), whereas crustacean consumption >once/week was associated with lower odds of high BPA exposure (OR: 0.27; 95% CI: 0.10–0.75). In women, large fish/tuna consumption >once/week (OR: 1.76; 95% CI: 1.00–3.20) and crustacean consumption >once/week (OR: 2.20; 95% CI: 1.09–4.43) were associated with higher odds of high BPA exposure.
Conclusions
Seafood-frequency categories showed associations with spot urinary concentrations of BPA, BPF, and BPS. These cross-sectional findings do not establish a causal relationship or a specific exposure pathway. Longitudinal studies with repeated urinary measurements and more detailed assessment of seafood products, processing, and food-contact materials are needed to clarify these associations.

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Original Article

Personal and environmental determinants of oxidative stress among the residents of Ulsan, South Korea: a combined approach of statistical and machine learning models: Chiwon Sung, Dong Yeop Lee, Miso Lee, Chang Sun Sim, Inbo Oh, Jin-Hee Bang, Dong Yoon Kang, Jiho Lee; Ann Occup Environ Med 2026;e41. Published online September 1, 2026; DOI: https://doi.org/10.35371/aoem.2026.38.e41 [Accepted]

Abstract PDF: Background
This study aimed to identify personal and environmental factors influencing malondialdehyde (MDA) levels, measured using thiobarbituric acid reactive substances (TBARS) assay, among residents of Ulsan, South Korea.
Methods
A total of 909 adult residents of Ulsan, recruited between 2022 and 2024, participated in a survey and urine analysis. The dependent variable was the natural log-transformed TBARS value (Ln_TBARS). The study examined 47 independent variables, including personal characteristics, socioeconomic factors, work-related exposures, residential area, and living environment. Residential areas were classified into three groups (A, B, and C) according to potential exposure to industrial hazardous air pollutants, determined jointly by proximity to large-scale industrial complexes and modelled concentrations of benzene, toluene, and xylene. Stepwise multiple regression, least absolute shrinkage and selection operator (LASSO) regression, and random forest (ntree = 500) were applied and compared to identify factors influencing oxidative stress levels among Ulsan residents.
Results
Residential area had the greatest impact on oxidative stress across all three models. Group C showed significantly lower Ln_TBARS levels than those in group A (stepwise: β = −0.395, p < 0.001; LASSO coefficient = −0.529; random forest: %IncMSE = 17.07%). Age and female sex were also consistently associated with oxidative stress across all three models (stepwise: β = 0.319, p < 0.001; LASSO coefficient = 0.014; random forest: %IncMSE = 12.67%, and stepwise: β = 0.152, p < 0.001; LASSO coefficient = 0.154; random forest: %IncMSE = 6.93%).
Conclusions
Residential area was the strongest predictor of oxidative stress across all three analytical models, with higher urinary MDA among residents of areas closer to industrial complexes; older age and female sex were also consistent predictors. These findings, robust across conventional statistical and machine-learning approaches, support systematic environmental health monitoring and targeted policy measures for residents near industrial zones.

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